The first time I ate bone marrow was, fittingly, shortly after I spoke on marrow failure at a conference in Milan, where osso bucco with saffron risotto is a local specialty. The tiny, back-alley trattoria where I could afford dinner on a hematology fellow’s salary was praised in a guidebook written by public television’s European travel guru, Rick Steves. (At the time, I bore a close resemblance to Steves. When friends later pointed this out, it suddenly was clear to me why Italian restaurant owners seemed so friendly and generous, and why antipasti so often showed up at my table “on the house.”)

I grew up in a middle-class home in 1970s suburban New Jersey, where food was plentiful but culinary options were limited. My Dutch mother was a competent cook and often made rich desserts, but dinners were heavy on boiled vegetables, mashed potatoes, and the less expensive cuts of meat from the local A&P supermarket. My dad grilled, but, like many men of his generation, he considered the linoleum-floored kitchen to be slippery foreign territory.

Our family didn’t go out to eat much – maybe once or twice a year – and either to the local red-sauce Italian restaurant, or a classic greasy-spoon diner owned by a family friend. I didn’t try seafood or any dish originating in Asia until I left for college. Eating bone marrow in a café in Milan, therefore, felt absurdly exotic.

Both the name and the hearty flavor of osso bucco come from the marrow in the center of a cross-cut veal shank. Chef Anthony Bourdain calls marrow “God’s butter,” and for good reason. Accurate nutritional information about marrow is surprisingly hard to come by, but marrow is so rich that, in his novel Walden, Henry David Thoreau made it a metaphor for carpe diem: “I wanted to live deep and suck out all the marrow of life.” High in protein, fats, and essential elements, and clocking in at around 250 calories per ounce, marrow packs a potent nutritional punch.

Once upon a time, back when indentured servants in New England complained about their masters serving them a diet with too much lobster (considered then a low-class meat because of the work involved in eating it), eating marrow was more common in the West than it is today. No proper 18th-century kitchen was complete without a marrow spoon, the scoop of which looks like a hypertrophied biopsy needle. Martha Stewart demonstrated the use of marrow spoons in a recent episode of her television show, ladling mouth-watering cooked marrow onto toasted croute and obviously enjoying herself, pronouncing, “It’s a good thing.”

Surely the English theologian and geologist William Buckland must have tried eating marrow. A noted 19th-century eccentric, Buckland was known for intentionally eating his way across the animal kingdom, from crocodiles to panthers to weasels. (He rated moles and bluebottle flies the lowest.) This obsession with edible adventure occasionally crossed over into the grotesque: At a party outside Oxford in which the desiccated heart of French King Louis XIV was being passed around, Buckland either intentionally or accidentally mistook the relic for a novel hors d’oeuvre and ate it, grievously offending his host.

While the majority of marrow eaten across the globe today comes from cows, this has not always been the case. There is anthropologic evidence that early humans used crude stone tools to break into wild animal bones and suck out the marrow. For a long time, humans were far from apex predators and could only have a go at the corpse of a downed animal after the lions and hyenas were done with it.

The use of stone tools to crack open marrow and get at a food source that no other creature could access ensured the survival of our ancestors, while the fatty marrow fueled their brain development. There is far less anthropologic evidence that our ancestors ate the marrow of one another, and perhaps that’s a good thing, because infectious prions such as the ones that transmit kuru can be found in marrow.

For many years I’ve been keeping back a story, looking for just the right forum in which to share it, and this seems as good a time as any, as well as a fitting last word.

I once saw an older patient in consultation for anemia. She had worked on the home front during World War II at the Hormel factory in Austin, Minnesota, where Spam is made. When I examined her, I noticed that she had only four fingers on one hand.

Where had the other one gone? She told me she’d lost it in a grinder at the factory during the war. I asked her if the manager had at least stopped the factory line to retrieve it. She shook her head, offering only a short explanation, “We had quotas.” On a later visit, she confessed that for years she had nightmares about some unfortunate 19-year-old GI opening up his C-ration meat tin after a long day spent storming Monte Cassino, only to find her digit and its marrow inside.

The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.

Have a comment about this editorial? Let us know what you think; we welcome your feedback. Email the editor at ACNEditor@hematology.org.

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